Healthcare that needs immediate attention

Everybody knows that the whole Hungarian healthcare system needs a thorough overhaul. In 2006-2007 there was an attempt to fix it when, during the coalition negotiations, MSZP no longer insisted on keeping the position of minister of health in the party's hands. But when Lajos Molnár of SZDSZ, who received the unpleasant task of trying to do something with the very sick healthcare system, tried to introduce some "reforms," he was attacked on all sides. The Hungarian medical association together with the "important" members of the profession turned against him and did everything to thwart his efforts. MSZP politicians tried to hold him back, fearing political repercussions. Everybody knew that at least fifty totally inadequate hospitals should be closed, but local interests put an end to all attempts at rationalizing health care. And then there was the "defender" of the profession: Fidesz. In the end, with the help of the constitutional court, the opposition managed to put an end to all attempts at change. One can even hypothesize that the Fidesz-inspired referendum on the issue of a co-pay amounting to one euro was responsible for the fall of the Gyurcsány government a year later.

One would have thought that Fidesz had a group of healthcare experts who were busily making plans for the overhaul of the system. Mind you, if there were such people they weren't visible. Between 2002 and 2006 István Mikola, one of the two ministers of health in the first Orbán government, seemed to be the most likely to be in charge of the ministry once they win the elections. Mikola, who at one point received the epithet "the doctor of the nation," remained a member of parliament after 2006 but he clearly lost his earlier influence. There was no obvious person to replace him.

When the rather confusing new governmental structure was set up, Miklós Réthelyi, a seventy-year-old anatomy professor and president of the medical school in Budapest in the early 1990s, became minister of national resources, and under him Miklós Szócska was named undersecretary in charge of health issues.  Although Szócska has a medical degree, he is much more interested in health management. He was active in setting up a center for the study of medical management at the Budapest medical school. It seems that the center was intended be a counterweight to liberal management centers. So, his ideas on medical reforms run along conservative lines, and he and his center caught the eyes of Fidesz politicians.

Szócska is true to his reputation. He is a conservative who seems to be reversing practically everything that remained of the reforms of Lajos Molnár. Although because of financial constraints he can't put more money into the system, he advocates certain steps that might satisfy the medical establishment for a while at least. He wants to make membership in the Hungarian medical association compulsory again, he wants to appease pharmacy owners by again restricting the establishment of new pharmacies and thus restoring the monopoly of current pharmacy owners. And finally, under his guidance a bill was prepared that would abolish an organization set up during Molnár's tenure that was supposed to investigate patients' complaints against hospitals and doctors. This supervisory body was a thorn in doctors' sides. The Hungarian medical association wants to handle complaints itself. They argue that if membership in the medical association is compulsory again, then the association's ethical committee can handle such cases. Well, we all know about these professional ethical committees.

As for Réthelyi, he seems like a very nice and totally ineffectual individual who has absolutely no idea what he is supposed to be doing. In fact, one has the impression that Réthelyi is "not quite with it." He is in a total fog.

In brief, not much is going on to improve the health system which only a few months ago we were told was close to total colllapse. Hospitals insisted on the immediate infusion of billions because otherwise they would have to close their doors. Interesting enough, although there is no money forthcoming, the hospitals are still functioning as much as Hungarian hospitals function. For better or worse.

Then out of the blue came István Mikola's announcement. The good old doctor/Fidesz member of parliament suddenly discovered that obstetricians demand money for their services if the expectant mother insists on having her own doctor throughout her pregnancy and at the time of childbirth. This is really funny because everybody knows that this is the norm. People ask why Mikola raised the issue. In fact he was so wound up that he threatened to report the case to the police.

Since then Mikola calmed down or perhaps someone from the party calmed him down, and he gave up the idea of going to the police. But now the medical establishment is up in arms. Although the spokesman of the assocation of obstetricians admits that demanding money ahead of time is illegal, he went on and on in an interview about the hard life of the gynecologist-obstetrician who in the dead of night has to drive his own car, using his own gasoline, to go to the hospital because his patient is going to deliver. Their remedy would be to make all this legal. If a woman insists on having her own doctor, she must pay. So the idea of extra money for non-basic services seems to be creeping in. This might actually be the only way to handle the situation, but it still is interesting to hear this from the same people who were so dead set against the one-euro co-pay because "money should not stand between the doctor and his patient." Everybody knows that yearly 70-100 billion tax-free forints go into the pockets of doctors. Indeed, it would be time to do something.